21 June 2006

Today, for the nth time, I saw a child in the ED who had a viral illness characterized by fever, runny nose, and a nonspecific rash, who was not immunized. The parents informed me that they had concerns about autism and mercury in vaccines and had elected to pursue "natural immunity."

I gritted my teeth against the flood of invective that threatened to pour forth (the last thing I need is more complaints), muttered a vaguely contemptuous "That's an interesting strategy," and moved on. The kid was fine and went home. Ironically, the parents were irritated not to be prescribed antibiotics. It boggles the mind.

The concerns about Thimerosal and autism have been well-documented, most notably in an article by Robert F Kennedy, Jr. in a Salon/Rolling Stone article which has since been debunked and contradicted by numerous sources, including the CDC, the American Academy of Pediatrics, and the Institute of Medicine. Orac, of Respectful Insolence, has a nice line-by-line rebuttal. This hasn't stopped Kennedy or his fellow-travelers, who cry "conspiracy" and "cover-up," and continue to spread their misinformation and hysteria. As a result, immunity rates worldwide are declining. In Britain, it has been reported that immunization rates to measles, mumps, and rubella (the most commonly implicated jabs), have fallen as low as 77%, below the level required to sustain herd immunity. Prime Minister Tony Blair refused to publicly confirm whether his newborn child had recieved the vaccine. The consequences are now coming to pass, predictably, and tragically.

There have been confirmed outbreaks of Measles in the UK, as well as Germany, and most recently in Massachusetts. Thousands of cases have been reported. Complications such as pneumonia, encephalitis, and even some deaths have been reported. (In fairness, it seems that only the English, Irish, and German outbreaks are thought to be in large part due to inadequate immunization practices; the Boston outbreak is apparently due to faulty vaccines used in the 60's and worldwide travel.) This, from a disease that had been thought to be all-but-eradicated only a few years ago.

I have never seen a case of measles in clinical practice. I guess I am going to have to make sure I know what it looks like, because by all evidence, I will be seeing it in a few years.

7 comments:

I enjoy your blog. You pi$$ me off and irritate me to no end, but I do enjoy reading your material and have learned from you.

My daughter believes the way your parents in this article do. I neither agree nor disagree. I have found with grown children, it is sometimes (sometimes being the operative word) best to just "hush".

There was one incident I became minimally involved in. She had her last daughter at home. This was her 3rd child and she was 27, healthy and she and hubby were "prepared".

When she took that brand new baby for her "newborn" check up 2 days after birth, she and her family were treated horribly by the pediatrician for the "unthinkable" act of giving birth at home. I won't go into details unless someone wants to know, but it was not pretty what they were put through over the course of the next two days, and without cause since all the unnecessary tests and painful procedures she put that baby through (with threats of getting the child welfare people involved if they didn't cooperate) all came out fine.

I wish that doctor had kept her mouth shut and (her mind open) like you chose to, then she would not have gotten that nasty letter from Granny (I know...she probably didn't even read it past the first flaming sentence. But Granny felt better.)

Pros and cons abound, however this is still America and it was their choice. The very thing she had tried to get away from by birthing at home wound up happening anyway.

I'm probably the type of parent that you can't stand, but perhaps not. I haven't given every innoculation available to my children, but they have had some. And no, the mercury thing doesn't even remotely bother me (I mean, how much mercury is in tunafish? Do we stay away from that too??). But I was really taken aback by the "chicken pox vaccine". Since when do we innoculate for something that mild and generally benign? Even my brother had an awful case of it, but it wasn't vaccine-quality. What happened to the days of playing with your friends "so you can catch it"?

So I got to thinking: What AM I vaccinating my children against? And a good many of the vaccines are legitimate. Tetanus can be fatal or debilitating. Polio, no brainer. Diptheria, scary. But rubella? Not a huge deal. Are there exceptions? Sure. As there are in chicken pox. But to the point where we need to vaccinate against it? Maybe not. Let's not even get started on Hep B for infants!!

Are we going to start vaccinating against 5ths Disease? Roseola? The sniffles?? That'd be crazy, and I dare say that health is not the main factor in a vaccine for a benign human malady such as those. Perhaps lost days at work for the parent? NOW I think we're on to something.

There are too many children that have had bad reactions (leaving autism out of it) to vaccines to not ask questions. And I'm appalled that docs expect us to accept these things blindly like lemmings (sorry, the drug company info they give out is biased). I, for one, am trying to be as informed as possible. Sometimes, that includes not making popular decisions.

At least, until I know more.

(And, no, I'm not a big one for antibiotics either. Recent studies seem to be backing me up on that one!)

Thanks for posting, and I'm glad that I can entertain and . . . um . . . provoke you. I'm surprised that your daughter got so much grief about the home delivery. They're pretty uncommon these days, and I'm no fan (being the father of a child who had cord compression and would have died without a crash c-section), but I'm sorry to see it being held as tantamount to child abuse.

Kelly,

Thanks for commenting. You're right that chicken pox is a more controversial vaccine. However, when you look at the big picture, it clearly is worth it. For example, my three-year-old got chicken pox despite the vaccine (about 10% of kids will). He was barely sick at all, it lasted maybe one day, had fewer than 20 spots (the average kid has 100-200), and no scarring. So I am damn glad we got the vaccine. And do remember that 1/100,000 kids will die from chicken pox. A small number -- about 100/year, before the vaccine. But if it's your kid?

I can't wait to hear the debate over the HPV vaccine that's coming out. . .

BTW, I don't "hate" parents like you. If nothing else, you're interested enough to ask questions and (it would seem) reasonable enough to listen to the answers. I get very frustrated seeing folks who take the anti-immunization rhetoric as a matter of religious faith, partly because they are immune to persuasion, and partly because I work in the ER which is not a good environment to have a discussion on the merits.

You know, we should also take into account children with serious illness. I have one handicapped child that I would not NOT vaccinate, only because she has enough complications as it is. She can't just take OTC remedies to alleviate her symptoms, like many children can.

I wonder if that 1/100,000 child had other serious complications to exacerbate their ability to fight off something like chicken pox. If that info was known, then perhaps the stats are far more remote than we think (ie: 1/1000000 of previously healthy children). I'd be interested to know that someday.

(BTW: I didn't say hate. You never really gave that impression with your post to begin with. Irritated maybe ;)

wonder what bad would have occurred if you had simply said to the parents "gee, that's a really bad idea"?

Well, the worst thing (for me) would that it would chew up a lot of time to have that discussion, on an irrelevant-for-the-moment topic, and time is in fact the most important currency in the ED.

Also, it likely would have been wasted time -- how likely I am, a total stranger, to change their minds? Obviously, they have thought about it and decided not to immunize, probably in spite of the advice from a pediatrologist they know and trust better than me. And it may well have pissed them off enough to generate a complaint (and the hospital administration hates complaints.

So I leave it be, and try to focus efforts where they are more likely to have an effect -- I do ask every smoker if they are planning to quit, and I often do alcohol counseling. Folks seem more open to that sort of intervention in the ED.

"But rubella? Not a huge deal. Are there exceptions? Sure. As there are in chicken pox. But to the point where we need to vaccinate against it? Maybe not."

My understanding is that the reason we vaccinate against rubella is not only for the children getting vacinated, but much more importantly to stop outbreaks of rubella in the community. Rubella can cause deafness, mental retardation, and heart defects in fetuses when contracted by the mother during the first trimester.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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